Bishop Distributing Flooring Claim Form Download Form (PDF) "*" indicates required fields RETAIL STORE INFORMATIONDate Submitted:*Store Name:Account #:*Contact Name:*Phone:Email:* Address: Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code CUSTOMER INFORMATION (If Applicable)Owner's Name:Phone:Address: Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PRODUCT INFORMATIONInvoice #:*item #:Quantity Purchased:*Item Description:CLAIM DETAILSWhen was the item issue noticed?:How much of the floor is affected?:Description of the issue:*Has anyone been to the jobsite to review?: Yes No If so, findings:Have any steps been taken to resolve the issue?:Recommendation for resolution: (Board repair, full replacement, replacement material only, etc.)INSTALLATION DETAILSIs the product installed?: Yes No If so, when was it installed?:Where is the product installed?: (i.e. Hallway, bathroom, basement, etc.)How was the product installed?: (i.e. Floating, direct glue, etc.)Who installed the flooring?: (i.e. Retailer, contractor, consumer, etc.)Type of adhesive used: (If Applicable)Type of fasteners used: (If Applicable)Type of underlay used: (If Applicable)Type of subfloor:HVAC information type:Were moisture test performed on the product and/or substrate?: Yes No If so, what were the results?:MAINTENENCE INFORMATIONWhat products/methods have been used to clean the flooring and with what frequency?:FILESIn order for us to process your claim, the manufacturer requires:Labor Bill* Drop files here or Select files Max. file size: 2 GB. With grout, adhesive, underlayment, etc. listed. Should include quote for tear-out and replacement related labor.Photographs showing the entire room* Drop files here or Select files Max. file size: 2 GB. Photographs showing the issue* Drop files here or Select files Max. file size: 2 GB. Photographs showing the use of moldings / transitions Drop files here or Select files Max. file size: 2 GB.
